Lessons from Flint

In April 2013, the city of Flint, Michigan switched its water supply from Detroit’s Department of Water and Sewerage —which drew from Lake Huron—to a local treatment plant that took water from the Flint River. The switch was made as a cost-saving measure for the struggling city. Almost immediately, residents began to complain about the water’s color, taste and odor. As it turned out, these would be the least of their worries.

Because water from the Flint River had high levels of bacteria, it was treated with additional chlorine. Chlorine reacts with organic material in the water to produce carcinogenic byproducts such as trihalomethanes; it also makes water more acidic, which corrodes pipes. Federal law mandates adding anti-corrosive agents to drinking water in large cities; but officials in Flint did not bother to follow the law.

After the city began drawing from the Flint River, its drinking water spiked in bacteria and trihalomethanes. Legionnaires’ disease appeared and caused at least 10 deaths. And worst of all: the acidic water corroded Flint’s old lead pipes, allowing lead to seep into the drinking water. Prolonged exposure to lead causes a range of incurable developmental problems; it is devastating to children.

Nearly three years after switching water sources, the Genesee County Health Department issued a public health emergency, and residents were told not to drink the water. By that time the damage to Flint’s children was widespread and irreparable.

Most public health emergencies are caused by terrorism, natural disasters or infectious diseases. Earthquakes, floods and hurricanes mobilize the Red Cross and the WHO. So do outbreaks of Zika, Ebola, Lassa or yellow fever, cholera, or tuberculosis. When a public health emergency is declared, the response is proportionate to the threat. Tens—sometimes hundreds—of millions of dollars are directed to the problem. But more than money, human capital is expended on a military scale to beat back the problem. Healthcare workers are flown into the affected area, and they remain—often at great personal risk—until the war is won. Or at least until the crisis has passed.

But the public health emergency in Flint was different. It was entirely preventable, and it was caused and exacerbated by misinformation and mismanagement. When the evidence for the crisis finally became inescapable, the response was slow, tepid and wholly inadequate.

What happened in Flint is, in many ways, analogous to the public health emergency that is this country’s opioid epidemic. Like the water crisis in Michigan, our problem with opioids was also caused by misinformation and mismanagement. Greed and malfeasance seemed to drive companies like Purdue Pharma to intentionally mislead healthcare professionals about the safety of their drugs. OxyContin was advertised as non-addictive, and misprescribed for chronic conditions that too often led to dependence, diversion, and death. Drug cartels smuggling huge quantities of cheap, pure heroin into the country didn’t help, and today, 22 years after OxyContin was introduced to the American pharmacopeia, we are awash in opioids and people are dying in record-high numbers.

As it was in Flint, the response to the opioid crisis has again been tepid and wholly inadequate. There’s no sign of “Doctors Without Borders” or C-5 cargo planes bringing supplies to stem the tide of addiction and destruction. There are no tent cities of field hospitals and 9 out of every 10 people in need of treatment for a substance use disorder don’t receive it. There’s too little help for too many in need, and for those without the money to pay for treatment, long waiting lists create a formidable—and often terminal—obstacle.

It is a perverse irony that it is much easier to obtain heroin than one of the three medicines approved for use in treating heroin addiction. Doctors may prescribe OxyContin or other opioids to an unlimited number of patients, but there are strict controls over how many can be offered buprenorphine, a drug that is shown to be an effective adjunct for the treatment of opioid addiction.

The federal government recently made additional funding available, and 12 states (including Missouri) won multi-million dollar grants to prevent opioid overdoses, largely by widely distributing naloxone, the opioid overdose reversal drug, more available. This is necessary but insufficient. It is analogous to combating a massive invasion of killer bees by making Epi-Pens more available to those in their path.

So more federal money is being released, and Missouri will get some of that too. In fact, nationally, $1 billion has been earmarked for dealing with the opioid crisis (mostly for treatment). Sounds like a lot until you consider that we spend $27.5 billion on HIV-AIDS every year.

There are no easy answers to the opioid crisis. But we can’t address this public health emergency with underfunded, halfhearted, incomplete measures. As a region and as a country, we have to mount a vigorous response. We have to wage war. And not a “war on drugs,” but a war on addiction, and a war to provide kids healthier responses to dealing with the pain that life sometimes dishes out.

There is no Jonas Salk for opioid use disorder and we don’t have the money or the scientific knowledge to inoculate every child with an anti-addiction vaccine. But we really can inoculate all school children with resiliency skills and protective factors to help insulate them from the risk factors they’ll face as teens.

NCADA is the region’s largest provider of this kind of programming. Last year we delivered it to 77,000 students (grades K-12) in 280 schools.  And it still isn’t enough because we cannot serve all kids in all grades in all schools. To beat back this epidemic and ensure that the next one won’t take root we need to do more. In the St. Louis area, with as little as $3 million in additional annual funding, we could inoculate all kids by implementing a comprehensive, region-wide prevention strategy.

Three million dollars. That’s 0.00069% of Purdue Pharma’s annual revenue, or an almost unmeasurably small 0.000077% of the Missouri state budget. To deprive the community of this ridiculously effective prevention programming is the epitome of being penny wise and pound foolish.

Today, in Flint, Michigan, the water is clean, but the corroded lead pipes make it still unsafe to drink. Until the entire municipal water infrastructure is replaced, it will continue to leach poison into Flint’s children.

Here in St. Louis, we need not tear up the streets nor break the bank to make this a healthier community full of kids who are less likely to appear in court rooms or jail cells, emergency rooms or, most tragically, caskets. We can transform our prevention infrastructure with a small but sustained investment.

We can eradicate this public health emergency. But the time to act is now, and the size of the response must match the size of the threat.

Howard Weissman is Executive Director of NCADA.

Categories: Commentary

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